scholarly journals Chronic Active Antibody-Mediated Rejection with Linear IgG Deposition on Glomerular Capillaries in a Kidney Transplant Recipient

Nephron ◽  
2020 ◽  
pp. 1-5
Author(s):  
Kenichiro Miura ◽  
Yoko Shirai ◽  
Naoto Kaneko ◽  
Tomoo Yabuuchi ◽  
Kiyonobu Ishizuka ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Cell Injury ◽  
Kidney Transplant Recipient ◽  
Hla Antigens ◽  
Human Leukocyte ◽  
Renal Hypoplasia ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Glomerular Capillaries

Glomerular IgG deposition is rarely observed in antibody-mediated rejection. Here, we report chronic active antibody-mediated rejection with linear IgG deposition on glomerular capillary walls in a pediatric kidney transplant recipient. A 6-year-old boy with bilateral renal hypoplasia underwent preemptive deceased-donor kidney transplantation. Five years after the transplantation, an allograft biopsy revealed chronic active antibody-mediated rejection with diffuse linear IgG deposition on glomerular capillaries. Anti-glomerular basement membrane antibody, donor-specific anti-human leukocyte antigen (HLA) antibodies, and anti-angiotensin II type 1 receptor antibody were negative. A multiplex antibody assay identified anti-major histocompatibility complex class I chain-related molecule A antibody. Additionally, a single-antigen bead assay identified autoantibodies to 12 non-HLA antigens, including vimentin and glutathione S-transferase theta-1. To investigate whether IgG autoantibodies in the patient’s serum bind to antigens on glomerular capillaries, we incubated the patient’s serum with 0-h biopsy specimens of tissue donated to the patient and a control subject, both obtained immediately after nephrectomy from respective donors. IgG signals were observed in neither patient nor control samples. Nevertheless, linear IgG deposition may be explained by the binding of autoantibodies to non-HLA antigens that are usually hidden and only exposed via severe endothelial cell injury. Further studies are needed to confirm the significance of non-HLA antibodies in glomerular IgG deposition.

scholarly journals Optimal Immunosuppression Strategy in the Sensitized Kidney Transplant Recipient

2021 ◽  
Vol 10 (16) ◽  
pp. 3656
Author(s):  
Danae Olaso ◽  
Miriam Manook ◽  
Dimitrios Moris ◽  
Stuart Knechtle ◽  
Jean Kwun
Keyword(s):  
Immune Response ◽  
Transplant Recipient ◽  
Kidney Transplant Recipient ◽  
Human Leukocyte ◽  
Immunosuppressive Regimen ◽  
Human Leukocyte Antigens ◽  
Donor Pool ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Leukocyte Antigens

Patients with previous sensitization events against anti-human leukocyte antigens (HLA) often have circulating anti-HLA antibodies. Following organ transplantation, sensitized patients have higher rates of antibody-mediated rejection (AMR) compared to those who are non-sensitized. More stringent donor matching is required for these patients, which results in a reduced donor pool and increased time on the waitlist. Current approaches for sensitized patients focus on reducing preformed antibodies that preclude transplantation; however, this type of desensitization does not modulate the primed immune response in sensitized patients. Thus, an optimized maintenance immunosuppressive regimen is necessary for highly sensitized patients, which may be distinct from non-sensitized patients. In this review, we will discuss the currently available therapeutic options for induction, maintenance, and adjuvant immunosuppression for sensitized patients.

scholarly journals Antibody-mediated rejection due to anti-HLA-DQ antibody after pregnancy and delivery in a female kidney transplant recipient

Nephrology ◽  
2018 ◽  
Vol 23 ◽  
pp. 81-84
Author(s):  
Makoto Sagasaki ◽  
Yasuyuki Nakada ◽  
Izumi Yamamoto ◽  
Mayuko Kawabe ◽  
Takafumi Yamakawa ◽  
...  
Keyword(s):  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Antibody Mediated Rejection ◽  
Hla Dq ◽  
Pregnancy And Delivery

Antibody‐mediated rejection with the presence of glomerular crescents in a pediatric kidney transplant recipient: A case report

2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Vasiliki Karava ◽  
Hara Gakiopoulou ◽  
Argyroula Zampetoglou ◽  
Smaragdi Marinaki ◽  
Sofia Havaki ◽  
...  
Keyword(s):  
Case Report ◽  
Transplant Recipient ◽  
Kidney Transplant ◽  
Kidney Transplant Recipient ◽  
Antibody Mediated Rejection

scholarly journals Autoantibodies Against Ro/SS-A, CENP-B, and La/SS-B are Increased in Patients with Kidney Allograft Antibody-Mediated Rejection

2020 ◽  
Author(s):  
Sergi Clotet-Freixas ◽  
Max Kotlyar ◽  
Caitriona M. McEvoy ◽  
Chiara Pastrello ◽  
Sonia Rodríguez-Ramírez ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Hla Antigens ◽  
Kidney Graft ◽  
Hla Antibodies ◽  
Antibody Mediated Rejection ◽  
Transplant Patients ◽  
Kidney Transplant Patients ◽  
Donor Specific Antibodies ◽  
Cellular Rejection ◽  
Independent Cohort

ABSTRACTAntibody-mediated rejection (AMR) causes >50% of late kidney graft losses. Although donor-specific antibodies (DSA) against HLA cause AMR, antibodies against non-HLA antigens are also linked to rejection. Identifying key non-HLA antibodies will improve our understanding of antibody-mediated injury.We analyzed non-HLA antibodies using protein microarrays in sera from 91 kidney transplant patients with AMR, mixed rejection, acute cellular rejection (ACR), or acute tubular necrosis (ATN). IgM and IgG antibodies against 134 non-HLA antigens were measured pre-transplant, at the time of biopsy-proven diagnosis, and post-diagnosis. Findings were validated in 60 kidney transplant patients from an independent cohort.Seventeen non-HLA antibodies were significantly increased (p<0.05) in AMR and mixed rejection compared to ACR or ATN pre-transplant, nine at diagnosis and six post-diagnosis. AMR and mixed cases showed significantly increased pre-transplant levels of IgG anti-Ro/SS-A and anti-CENP-B, compared to ACR. Together with IgM anti-CENP-B and anti-La/SS-B, these antibodies were also significantly increased in AMR/mixed rejection at diagnosis. Increased IgG anti-Ro/SS-A and anti-CENP-B pre-transplant and at diagnosis, and IgM anti-La/SS-B at diagnosis, were associated with the presence of microvascular lesions, but not with tubulitis or interstitial/total inflammation. All three antibodies were associated with the presence of class-II DSA (p<0.05). Significantly increased IgG anti-Ro/SS-A in AMR/mixed compared to ACR (p=0.01), and numerically increased IgM anti-CENP-B (p=0.05) and anti-La/SS-B (p=0.06), were validated in the independent cohort.This is the first study that implicates autoantibodies against Ro/SS-A and CENP-B in AMR. These non-HLA antibodies may participate in the crosstalk between autoimmunity and alloimmunity in kidney AMR.SIGNIFICANCE STATEMENTAntibody-mediated rejection (AMR) causes >50% of kidney graft losses. Although donor-specific antibodies against HLA cause AMR, antibodies against non-HLA antigens are also linked to rejection. Serum samples of 91 kidney transplant patients were analyzed using protein arrays against 134 non-HLA antigens. AMR and mixed rejection cases showed significantly increased pre-transplant levels of IgG anti-Ro/SS-A and anti-CENP-B, compared to acute cellular rejection. Together with IgM anti-CENP-B and anti-La/SS-B, these antibodies were significantly increased in AMR/mixed rejection at diagnosis and were validated in a second, independent cohort. Increased IgG anti-Ro/SS-A, IgG anti-CENP-B and IgM anti-La/SS-B were associated with the presence of microvascular lesions and anti-HLA class-II antibodies. This is the first study to implicate anti-Ro/SS-A, anti-La/SS-B and anti-CENP-B autoantibodies in AMR.

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